All Inside Arthroscopic Foveal Reattachment of the Triangular Fibro Cartilage Complex
Didier Fontès, MD; Gwénolé Kermarrec, MD
Hôpital Saint Antoine, Paris, France
Foveal attachment of the triangular fibrocartilage complex (TFCC) is essential for distal radioulnar joint (DRUJ) stability, nevertheless management of its lesions remains actually controversial. Arthroscopic techniques previously described require either mini open steps or are complex and expensive. We present a simple all inside knotless repair providing a strong bony fixation into the fovea.
Material and method
Through 3-4 and 6R portals, TFCC lesion is assessed, the ulnar fovea is debrided and a blind hole of 2.0 mm diameter is achieved. With the help of a simple 18 gauge needle two strands of 2-0 Fiberwire® are introduced percutaneously through the TFCC accommodating a mattress suture on its free end. The suture tails are passed through the eyelet of the 2.5 mm Pushlock® anchor (Arthrex®) and precisely introduced at the bottom of the hole. The tack portion of the anchor is impacted optimizing tissue tension and fixation (without any knot tying). The handle is removed and the sutures flush are cut achieving an accurate and no-profile repair.
Retrospective and preliminary study:
Between 2013 and 2016, a cohort of 5 patients with Palmer 1B, EWAS 2 lesion of the TFCC were evaluated (grip strength, pain, range of motion and DRUJ stability). Functional scores have been documented: Mayo Modified Wrist Score (MMWS), Quick DASH and the PRWE. The average follow up was 29,4 months ( 9-42 months). MRI control was performed for 3 patients.
Pain was reduced of 5, grip strength and range of motion averaged more than 90% of the unaffected side and DRUJ instability was improved. MMWS was excellent for 1, good for 1 and satisfactory for 3 patients. Quick DASH improved of 43. PRWE reported an amelioration of 41. We reported no complications and MRI confirmed the accurate positioning of the anchor and the achieving of ligamentous healing.
Preliminary results seems to be similar to conventional mini-open techniques but our procedure appears to be quicker, reproducible and straightforward to provide a secure means of knotless reattachment of foveal TFCC. Nevertheless, further investigation with an increased number of patients is required. It however became our first choice option for treatment of EWAS 2 TFCC lesions.
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